Keys to Managing Your Shoulder Pain

Shoulder pain is a game changer. A painful shoulder can quickly limit the activity level for athletes and non-athletes alike.

The shoulder joint is the most mobile joint in your entire body.  With that being said, eliminating the pain in such loose joint is no easy task.

7 Sports Medicine Tips to Manage Your Shoulder Pain.

Pendulum Swings – With the hand of the pain-free shoulder resting on a chair and a 10-15 lbs weight in the other hand, slowly move the weighted hand in a slow circular motion.  This will distract and relax the muscles surrounding the painful shoulder joint. Swing the hand/arm like a pendulum in both clockwise and counter-clockwise directions.

Pliable Chest Muscles – Longer and more flexible chest muscles are vital for a happy pain-free shoulder. Start by aggressively massaging the deep chest muscles with fingers or a baseball (warning; it hurts but it works). Next, stretching the superficial chest muscles in a door frame is a simply way lengthen your broad, strong chest muscles.  By doing so, the more flexible chest muscles will now allow for greater mobility of three (3) bones which make up your shoulder girdle (upper arm bone, shoulder blade & collar bone).

Strong Shoulder Blade Stabilizers – You have 17 muscles anchored to each of your shoulder blades.  Keeping your upper back strong helps protect the shoulder joints by controlling the intricate motions of the shoulder blade.  To do so, seated rows, bent-over flies, cable “T’s” and good ol’ scapula squeezes need to be part of your shoulder plan.

Enduring External Rotators – Of the four (4) muscles forming your rotator cuff, the two external rotators are the most important when it comes to prevent shoulder injury.  The key factor with shoulder external rotators is not just strength. Hence, having great endurance of the external rotators should be your goal.  Doing high repetitions (>15 reps) using cable weights or simple exercise bands will help accomplish this.

Overhead Stretches – Add low-intensity pain-free overhead stretches to your routine. Examples include 25-50% body weight hangs from a pull-up bar/door frame or bend-over stretches with hands on a high counter.

Limited Overhead Strengthening – Anytime you perform strength work above your shoulder level, you’re increasing the stress on your rotator cuff. You can sufficiently strengthen all your shoulder, back and chest muscles without ever elevating your elbows above your shoulder.

Strong Posture – Daily tasks like driving, working on a computer and carrying objects all contribute to poor posture and shoulder pain.

Strong posture = Shoulder blades “back and down” + chin over ribs

The Quest for Happy Shoulders

Most of the painful shoulder joints I treat have key problems related to their shoulder girdle. These 7 sports medicine tips will help you protect two very important joints.

Remember this simple formula: Happy shoulders have mobile shoulder girdles, great endurance of their external rotators and strong upper back muscles.

Subacromial Bursitis Made Easy

Understanding Shoulder Bursitis

The subacromial bursa is a thin sac-like structure that is located just under the acromioclavicular or AC joint of the shoulder.  The bursa lies over the top of the rotator cuff.  The bursa acts as a lubricating buffer between the rotator cuff and the undersurface of the lateral clavicle and acromion process of the scapular, both of which articulate with each other to form the AC joint.

The subacromial bursa’s main function is to reduce the friction on the upper layers of the rotator cuff and humeral head during shoulder motion.  As a thin fluid filled sac, similar to a slim water-balloon, the subacromial bursa is quite efficient in acting as a friction reducer for the head of the humerus, the long-head of the biceps tendon and the all-important rotator cuff.  With the amount of motion and stress associated with the shoulder joint, the subacromial bursa has a difficult task each and every day even without involving direct contact to the shoulder girdle.

Rotator cuff tendonitis or a shoulder impingement syndrome are commonly associated with chronic subacromial bursitis.  It is not unusual to have a chronic rotator cuff injury which would alters the mechanics of the shoulder joint resulting in an inflammation of the subacromial bursa.  That is why it’s important to determine if there are any additional upper extremity or torso imbalances or injuries that require treatment when a player demonstrates a bursitis involving the shoulder.

Signs & Symptoms of Subacromial Bursitis

  • Generalized stiffness of the shoulder joint, mostly on the top and front of the shoulder.
  • An increase in symptoms generally associated with either a direct blow to the front of the shoulder joint or a significant increase in shoulder activities usually involving overhead-type activities.
  • A sense of weakness or loss of strength with activities involving the shoulder.
  • A localized puffiness or pocket of swelling in the upper-front area of the shoulder just below the AC joint.  This isolated pocket of swelling becomes more evident when the arm is extended at the shoulder.
  • Active shoulder elevation and abduction demonstrates weakness.

Professional Treatment for Subacromial Bursitis

  • Eliminating all activities that contributed to the bursitis such as excessive overhead activities, trauma or contact to the shoulder, weight training above shoulder level, painful motions during activities of daily living or hanging heavy object like luggage on the involved shoulder.
  • Consistent icing of the front, top and back of the shoulder.
  • Utilization of the necessary therapy modalities to decrease pain and reduce swelling.
  • Easy pendulum swings with no more than 5 lbs.
  • Passive and painfree range of motion (ROM) of the shoulder joint to include flexion, abduction, horizontal abduction and external rotation while minimizing the motions of shoulder extension and horizontal adduction.
  • Progressive resistive strengthening of shoulder external rotation, if painfree.
  • Avoid sleeping on this shoulder while swelling and/or pain remains.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this an isolated bursitis or do I have other shoulder issues that I need to treat?
  2. Do I have any damage to my rotator cuff?
  3. In your opinion, why did I get this injury and how can I avoid these types of injuries in the future?
  4. Will I need to have this bursa injected with any anti-inflammatory medication in the future?

Elite Sports Medicine Tips from Mike Ryan

  • Looks Worse – Bursitis often looks worse than it feels.
  • Treat Right the First Time – It may not hurt at first but with it’s proximity to the rotator cuff, you don’t want it to spoil the party in the should and become a chronic nightmare.
  • Ice is Key – I know I wear out the “ice thing” but it’s a key tool to quiet down bursitis cool and to reduce localized swelling.
  • Find the Source – If the reason for the bursa swelling is unknown, dig deeper to find out why.  Find the real reason often avoids major shoulder complications a couple of weeks from now.
  • Avoid the Knife – Some will quickly offer a “simple surgical solution”.  Run away as fast as possible and reread this article.